Alfonsa Kyles
Med-Metrix
Mobile
1
Certification
14
years of professional experience
Certified Billing and Coding Specialist with over five years of experience. Adept at collecting patient information, maintaining efficient office skill, and coordinating with medical professionals. Extensive knowledge of Revenue Cycle Process and commitment to patient happiness.
Work History
Revenue Cycle Specialist
2 Months- Collaborated with healthcare providers to resolve billing discrepancies and improve payment timelines.
- Processed and submitted insurance claims to ensure timely reimbursements.
- Verified insurance of patients to determine eligibility.
- Collaborated with cross-functional teams to optimize revenue cycle management processes.
- Analyzed denial trends to identify root causes and improve claim acceptance rates.
- Collaborated with healthcare providers to resolve payment issues and enhance reimbursement processes.
- Increased customer satisfaction ratings through timely follow-up on appeal status inquiries, providing accurate information and addressing concerns promptly.
- Corrected coding of claim and resubmit corrected claim to insurance provider.
- Worked denial by correcting coding error or submitting appeals explaining medical necessity through providers portal
Revenue Cycle Specialist
3 Years 9 Months- Analyzed revenue cycle process
- Implemented software solutions to streamline patient acreceivable management and reporting.
- Worked effectively in fast-paced environments.
- Upheld strict confidentiality standards to protect sensitive patient information in accordance with HIPAA regulations.
- Processed medical claims using billing software to ensure timely reimbursement.
- Collaborated with medical coders to ensure proper use of CPT, ICD-10, and HCPCS codes for accurate claim submission and compliance with industry standards.
- Facilitated communication between stakeholders to resolve lien-related inquiries effectively.
Revenue Cycle Specialist
1 Year 2 Months- Complied with all HIPAA Privacy and Security Regulations to protect patient's medical records and information
- Handled, initiated, and faxed UB-04, CMS 1500 and medical records to patient's insurance company. Experience in billing auto insurance, commercial/government insurance, and worker's comp.
- Responsible for obtaining patient's worker's comp, auto, or commercial insurance. Knowledgeable in PIP states and non PIP states. Responsible for billing patient commercial insurance before the timely filing date.
- Received and reviewed EOBs to check if insurance needs more information to pay for medical bill or if the benefits have been exhausted. Handled settlements from insurance company or attorney office and adjusted balance via software Meditech
- Prevented financial delinquencies by working closely with managers to ensure billing issues were resolved before becoming unmanageable.
- Contacted insurance companies to follow up on bill status for payment.
- Reached out to insurance companies to verify coverage.
Patient Access Representative
1 Year 9 Months- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks
- Tracked referral submission during facilitation of prior authorization issuance.
- Worked patients accounts through Epic by inserting the correct CPT codes and diagnostic codes
- Explained estimated cost for medical treatments and answered patient questions to promote good understanding of proposed services.
- Determined patient financial needs and referred eligible patients to proper county, state or federal agencies to obtain financial assistance.
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient privacy.
- Utilized Epic to manage and confirm patient data, such as insurance, demographic and medical history information.
- Trained new agent as team lead by relaying information on company procedures, HIPAA compliancy, managing Epic and phone etiquette.
Customer Service Representative
3 Years 1 Month- Resolved customers service billing complaints by performing activities such as exchanging merchandise, refunding money, or adjusting bills.
- Provided excellent customer service to patient by provided thorough explanation of medical bill, provided information in regards to financial assistance, and offered discounts that would help reduce the cost of patient's bill
- Processed payment via telephone with focus on accuracy and efficiency.
- Obtain patient medical insurance and forward information to the accurate department for billing
- Accepted payments for outpatient and inpatient services and also provided billing explanation and charges to patients.
- Took copayments and compiled daily financial records.
- Offered simple, clear explanations to help clients and families understand hospital policies and procedures.
- Handled outbound and inbound calls daily with goal of collecting owed debt.
Insurance Information Coordinator
6 Months- Coordinated patient account documentation to support accurate revenue cycle workflows and claim resolution.
- Reviewed insurance and billing information to ensure data accuracy before downstream processing.
- Tracked account updates in multiple systems to maintain consistent records and case status.
- Reviewed complex appeals, verifying claim details, policy language, and supporting documentation for accurate determinations.
- Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
- Increased clients satisfaction through timely follow-up on appeal status inquiries, providing accurate information and addressing concerns promptly.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Maintained confidentiality of patient finances, records, and health statuses.
- Locating EOBs and researching which denial codes are appealable and submitting appeals and reconsiderations to different health insurances via mail or payer portals (UHC and Availity)
Call Center Representative
2 Years 4 Months- Enhanced productivity by staying on top of call scripts and maintaining control over direction of conversations.
- Adhered to company policies and scripts to consistently achieve call-time and quality standards.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Conferred with customers by telephone to provide information about products or services, took or entered orders, canceled accounts, or obtained details of complaints.
- Checked to ensure that appropriate changes were made to resolve customers' problems.
- Kept records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
- Assisted trainees and employees of the company on positive positioning and billing explanation
Education
Associate of Science - Social Sciences Education
Medical Records
Skills
Insurance Billing
Scheduling
HIPAA Regulations
Medical Coding
Financial Consulting
Data entry
Supervisory training
Insurance Knowledge
CPT Coding
Medical Records Management
Insurance verifying
Managing records
Epic competency
Meditech software proficiency
Claims review
Claims processing proficiency
Medical billing expertise
Revenue cycle management
Multitasking
Verbal communication
Active listening
Certification
Certified Billing and Coding Specialist (CBCS) by the National Healthcareer Association
Timeline
Insurance Information Coordinator
Med-Metrix
04.2026 - CurrentRead More
Revenue Cycle Specialist
Medix Staffing
12.2025 - 02.2026Read More
Revenue Cycle Specialist
KNOWTION
12.2021 - 09.2025Read More
Revenue Cycle Specialist
First Financial Asset Management Inc.
09.2020 - 11.2021Read More
Patient Access Representative
GetixHealth
10.2018 - 07.2020Read More
Customer Service Representative
Trubridge
09.2015 - 10.2018Read More
Call Center Representative
Alorica
04.2013 - 08.2015Read More
Atlanta Metropolitan State College
Associate of Science from Social Sciences Education
Read More
University of Phoenix
Medical Records
Read More